In many countries, use of neuroleptic (antipsychotic) drugs has soared since the market introduction of second-generation (or "atypical") neuroleptics in the 1980s: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine and risperidone. The number of prescriptions rose rapidly because these drugs were said to have a better adverse effect profile than that of first-generation neuroleptics.

A team of pharmacoepidemiologists from France's National Institute of Health and Medical Research (INSERM) have pointed out that, although they provoke fewer neurological adverse effects in the short term than neuroleptics such as haloperidol, the second-generation drugs have more marked metabolic adverse effects, such as diabetes and dyslipidaemia. Both types of neuroleptics are associated with excess mortality.

Yet the number of prescriptions for these drugs has continued to rise, in particular in unauthorised indications such as anxiety disorders, mood disorders and dementia. These drugs are also prescribed to children and adolescents, in attention deficit hyperactivity disorder and autism for example.

This broad use of neuroleptics is troubling, mainly because these drugs carry a risk of cardiac disorders and excess mortality. These drugs are too readily prescribed for children and adolescents, despite the lack of data on their potential impact on the developing brain.

And so, as in other cases, new drugs, hailed (mainly by pharmaceutical companies) for their superior adverse effect profile, replaced older drugs whose efficacy was established and whose adverse effects were better known.

Healthcare professionnals must base decisions on robust data, rather than on hopes and on claims made by pharmaceutical companies.

©Prescrire 1 February 2017

"Neuroleptics: too readily prescribed" Prescrire Int 2017; 26 (179): 31. (Pdf, free).